The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) provides evidence based clinical practice guidelines developed for all phases of kidney disease and related complications, from diagnosis to monitoring and management. Bone disease sets in during the early stages of Chronic Kidney Disease (CKD). Bone disease is observed in almost patients with chronic renal failure and after renal transplantation. Hyperparathyroid (high turnover) bone disease in patients with chronic renal failure is found most frequently followed by mixed osteodystrophy, low-turn over bone disease, and osteomalasia...

Correlation between renal disease and trace elements includes following two types; 1) Renal failure due to excess of trace element intake into the body, such as itai-itai disease or heavy metal intoxication. 2) Disturbances of trace elements in patients with chronic renal failure, such as aluminum dementia and aluminum-related bone disease. Itai-itai disease occurred by water pollution with cadmium. Cadmium causes Fanconi syndrome in the kidney and osteomalasia in person, especially in old women, who were living near the riverside...

We performed parathyroidectomy for renal osteodystrophy due to secondary hyperparathyroidism on 16 patients with chronic renal failure who were refractory to medical management; subtotal parathyroidectomy on one patient and total parathyroidectomy with autotransplantation on 15 patients. Postoperative clinical improvement, i.e., bone and/or joint pain, pruritus and radiographic signs of renal osteodystrophy, was marked. After the operation, serum calcium decreased rapidly and adequate calcium replacement therapy was necessary...